PANEL 7.1 IS THERE A BETTER WAY TO TRACK NUTRITION SPENDING? CLARA PICANYOL
T
he ability to track financial resource flows to nutrition actions is fundamental to improving accountability to citizens—yet it is difficult for countries, donors, UN organi- zations, and NGOs alike to achieve. A review of the state of financial resource tracking of 51 of the Scaling Up Nutrition (SUN) coun- tries concluded that general information on national budget allocation was publicly acces- sible for only 32 of the 51 countries, and in 4 of the 32 the information was out of date or insufficiently detailed (Picanyol and Fracassi 2014). It also showed that different countries use different methods to track budget alloca- tions and expenditures on health, including public expenditure reviews (PERs), national health accounts, the Clinton Health Access Initiative Resource Map tool, and public expenditure tracking surveys. These tools vary in their coverage, frequency of data collection, and the time and financial resources needed to use them (Picanyol 2014). Tanzania, for instance, is finalizing a PER
on nutrition. PERs, which have been widely used in other sectors in Tanzania, assess the level and composition of actual public
expenditures over a period (usually three to five years) against a predetermined set of policy goals and outputs in the national plan and make recommendations. The PER process raised a number of challenges. The integrated nature of programs with nutrition compo- nents, combined with insufficiently disag- gregated expenditures, meant that it was extremely difficult to isolate nutrition expendi- tures without the help of major assumptions. In addition, the government had difficulty retrieving expenditure information from donors and NGOs.
Madagascar developed a mechanism to track nutrition investments with the aim of estimating both existing and additional resources needed to finance the National Plan of Action for Nutrition (NPAN II). The National Office for Nutrition undertook a survey in line with the strategies, interventions, and activ- ities in the NPAN II and sent it to all stake- holders. The main challenges included the ministries’ limited knowledge of nutrition- related investments and some agencies’ lim- ited transparency or breakdown of budgets.
Also, little information was collected from civil society organizations and the private sector. Based on the review of published data from national budgets, it seems most fea- sible for countries to undertake a basic data-gathering exercise on nutrition-rele- vant budget allocations with the assistance of a spreadsheet template. The data can then be categorized into nutrition-specific and nutrition-sensitive categories using national or international definitions. Categorization and attribution will likely require consulta- tions with nutrition stakeholders in country. Although this approach may have initial limitations in terms of accuracy, once all the relevant information is collected, coun- tries may choose to refine their tracking system, improving accuracy over time. The data-gathering exercise should be transpar- ent, all steps taken should be documented in detail, and specific data sources should be provided. Such an approach will allow for comparison over time within a country and can promote accountability.
Countries
Increasing domestic resources to nutrition represents the only sustainable way of improving nutrition status. While donor resources are vital, they cannot—and should not—fill the un- dernutrition resource gap on their own. For example, it would require approximately US$70 billion to scale up nutrition- specific interventions to 90 percent coverage over the seven-year Nutrition for Growth (N4G) commitment period, 2013–2020.2
At the N4G Summit, donors committed an addi- tional US$4 billion of funding. This is a considerable amount, but it is only 6 percent of what is required. More domestic resources need to be mobilized.
The first step in mobilizing additional resources is to assess
current levels of domestic resource allocation. However, only a few countries have started tracking investments in nutrition— among them, Madagascar and Tanzania (Panel 7.1). Guatemala has probably done the most to establish a well-functioning system for monitoring its nutrition expenditures (Panel 7.2).3 As Guatemala’s experience shows, better tracking of resources depends on better planning and more realistic costing of nu- trition investment options. It also depends on the creation of a
48 GLOBAL NUTRITION REPORT 2014
supportive context where the capacity to track resources is built up and governance incentives are developed to better identify and track resources.
Donors
Bilateral and multilateral donors and foundations are vital drivers behind global and country-level commitments to nutrition be- cause of their power to convene other actors, their knowledge assets, and their financial resources.
For 2014, the reporting aims of the Global Nutrition Report for donor funding are modest for several reasons. First, this report should not be considered a report on financial progress against the N4G commitments. At the earliest, the response to these seven-year commitments would only be implemented in financial years 2013–2014 or 2014–2015, and the reporting on these years will begin to emerge only in 2015. Therefore the 2014 Global Nutrition Report should be viewed as a baseline to the N4G period.
Second, the N4G signatories do not include all donors. Other donors, for example, include South Korea, Spain, and Switzerland; the emerging powers such as China, India, and the
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